title: Recipient's unemployment restricts access to renal transplantation.
abstract: Equitable distribution of a scarce resource such as kidneys for transplantation can be a challenging task for transplant centers. In this study, we evaluated the association between recipient's employment status and access to renal transplantation in patients with end-stage renal disease (ESRD). We used data from the United States Renal Data System (USRDS). The primary variable of interest was employment status at ESRD onset. Two outcomes were analyzed in Cox model: (i) being placed on the waiting list for renal transplantation or being transplanted (whichever occurred first); and (ii) first transplant in patients who were placed on the waiting list. We analyzed 429 409 patients (age of ESRD onset 64.2 ± 15.2 yr, 55.0% males, 65.1% White). Compared with patients who were unemployed, patients working full time were more likely to be placed on the waiting list/transplanted (HR 2.24, p < 0.001) and to receive a transplant once on the waiting list (HR 1.65, p < 0.001). Results indicate that recipient's employment status is strongly associated with access to renal transplantation, with unemployed and partially employed patients at a disadvantage. Adding insurance status to the model reduces the effect size, but the association still remains significant, indicating additional contribution from other factors.
authors.affiliation: Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. sandhugs@upmc.edu
authors.forename: Gurprataap S
authors.initials: GS
authors.lastname: Sandhu
authors.forename: Muhammad
authors.initials: M
authors.lastname: Khattak
authors.forename: Martha
authors.initials: M
authors.lastname: Pavlakis
authors.forename: Robert
authors.initials: R
authors.lastname: Woodward
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Hanto
authors.forename: Marcy A
authors.initials: MA
authors.lastname: Wasilewski
authors.forename: Noelle
authors.initials: N
authors.lastname: Dimitri
authors.forename: Alexander
authors.initials: A
authors.lastname: Goldfarb-Rumyantzev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014478:Unemployment; D014481:United States; D014850:Waiting Lists; D055815:Young Adult
keywords: access; disparity; employment; renal allograft; transplant; waiting list